Place de l’auto-prélèvement « à domicile » dans les stratégies de dépistages du VIH et des autres infections sexuellement transmissibles chez les hommes ayant des relations sexuelles avec des hommes en France

Despite a high screening rate in the men who have sex with men (MSM),, the frequency remains insufficient to tackle the epidemy. This research aims to position home-based self-sampling within the screening strategies for HIV and other STIs among MSM in France. It is based on the data from the MémoDépistages research project. Participants were recruited online between April 11 and June 10, 2018 and received a self-sampling kit. An 18-month follow-up with quarterly reminders for HIV testing was offered. Participants could access new testing kits through the research or use traditional testing facilities. The online offer reached MSM highly exposed to STIs and overcame the geographical barriers. The quality of the samples allowed to communicate a result to a large majority of the participants (81,6%). Offering to screen for several infections in the same kit was attractive and allowed to identify undiagnosed infections. Access to this new testing tool ensures “cooperation” between screening methods to reach a broader population and facilitate repeated screening. It brought a solution for occasional difficulties in accessing other methods. Testing using self-sampling kits for one or more STIs is feasible and attractive for MSM and should be added to the French screening landscape to reinforce existing strategies and complement them.L’effort de dépistage du VIH est important chez les hommes ayant des relations sexuelles avec d’autres hommes (HSH) mais doit être renforcé pour atteindre les 4 dépistages annuels recommandés. L’objectif de cette thèse est de définir la place de l’auto-prélèvement « à domicile » dans les stratégies de dépistages du VIH et des autres infections sexuellement transmissibles chez les HSH en France en s’appuyant sur les données du programme de dépistage répété « MémoDépistages ». Recrutés en ligne entre 11 avril au 10 juin 2018, et suivi durant 18 mois, les inscrits recevaient un kit pour réaliser des prélèvements à domicile à renvoyer à un laboratoire. Les participants pouvaient accéder à de nouveaux kits ou utiliser les modalités traditionnelles de dépistage au cours du suivi. L’offre a atteint des HSH très exposés aux IST et a effacé les barrières géographiques d’accès au dépistage. La qualité des prélèvements a permis un rendu de résultat à une grande majorité des participants (81,6%), attestant d’une bonne faisabilité. L’accès à plusieurs dépistages a constitué un atout et a permis d’identifier des nouvelles infections à VIH, VHC, Chlamydia trachomatis et Neisseria gonorrhoeae. L’accès à cette nouvelle offre a assuré une « coopération » entre les modalités de dépistages pour atteindre une population plus large et a facilité la répétition du dépistage en compensant des difficultés ponctuelles d’accès aux autres modalités. Les kits d’auto-prélèvement pour plusieurs IST ont une place dans le paysage de dépistage français chez les HSH, tant en renforcement des stratégies existantes qu’en compléments de celles-ci

The role of at-home self-sampling among testing strategies for HIV and sexually transmitted infections in men who have sex with men in France

L’effort de dépistage du VIH est important chez les hommes ayant des relations sexuelles avec d’autres hommes (HSH) mais doit être renforcé pour atteindre les 4 dépistages annuels recommandés. L’objectif de cette thèse est de définir la place de l’auto-prélèvement « à domicile » dans les stratégies de dépistages du VIH et des autres infections sexuellement transmissibles chez les HSH en France en s’appuyant sur les données du programme de dépistage répété « MémoDépistages ». Recrutés en ligne entre 11 avril au 10 juin 2018, et suivi durant 18 mois, les inscrits recevaient un kit pour réaliser des prélèvements à domicile à renvoyer à un laboratoire. Les participants pouvaient accéder à de nouveaux kits ou utiliser les modalités traditionnelles de dépistage au cours du suivi. L’offre a atteint des HSH très exposés aux IST et a effacé les barrières géographiques d’accès au dépistage. La qualité des prélèvements a permis un rendu de résultat à une grande majorité des participants (81,6%), attestant d’une bonne faisabilité. L’accès à plusieurs dépistages a constitué un atout et a permis d’identifier des nouvelles infections à VIH, VHC, Chlamydia trachomatis et Neisseria gonorrhoeae. L’accès à cette nouvelle offre a assuré une « coopération » entre les modalités de dépistages pour atteindre une population plus large et a facilité la répétition du dépistage en compensant des difficultés ponctuelles d’accès aux autres modalités. Les kits d’auto-prélèvement pour plusieurs IST ont une place dans le paysage de dépistage français chez les HSH, tant en renforcement des stratégies existantes qu’en compléments de celles-ci.Despite a high screening rate in the men who have sex with men (MSM),, the frequency remains insufficient to tackle the epidemy. This research aims to position home-based self-sampling within the screening strategies for HIV and other STIs among MSM in France. It is based on the data from the MémoDépistages research project. Participants were recruited online between April 11 and June 10, 2018 and received a self-sampling kit. An 18-month follow-up with quarterly reminders for HIV testing was offered. Participants could access new testing kits through the research or use traditional testing facilities. The online offer reached MSM highly exposed to STIs and overcame the geographical barriers. The quality of the samples allowed to communicate a result to a large majority of the participants (81,6%). Offering to screen for several infections in the same kit was attractive and allowed to identify undiagnosed infections. Access to this new testing tool ensures “cooperation” between screening methods to reach a broader population and facilitate repeated screening. It brought a solution for occasional difficulties in accessing other methods. Testing using self-sampling kits for one or more STIs is feasible and attractive for MSM and should be added to the French screening landscape to reinforce existing strategies and complement them

Medical contraceptive use in the French population: Can we explore it based on the national health insurance data?

Study question Are French national health insurance data reliable for studying the use of medical contraception? Summary answer Health insurance data produce a measurement of contraceptive use consistent with population-based survey data, which affords new opportunities for studying contraception. What is known already Medical contraception is a major public health issue as most women of reproductive age use it. It is usually studied through population-based surveys. However, such surveys are conducted only every 10 years, and analyses are limited by their sample size. French national health insurance data provide comprehensive and time-continuous information on each reimbursed contraceptive. However, because these data have been collected for a different purpose (reimbursement), their relevance for measuring the use of contraceptives needs to be assessed. Study design, size, duration Two sources were analysed. First, a cross-sectional cohort was extracted from the health insurance database, which includes all health reimbursements (such as those for medical contraceptives) and covers 98% of the French population, including 14 million women aged 15–49. Secondly, we used the last French survey on contraception, a cross-sectional study including 4,508 women aged 15–49 interviewed by phone. Participants/materials, setting, methods From both sources, we selected all women aged 15–49 living in metropolitan France. We identified the last medical contraceptive purchased by each woman between 2014 and 2019. The woman was then classified as currently using this contraceptive if the recommended duration of use for this contraceptive was still ongoing on 31 December 2019. Prevalences were compared to those observed in the population based survey. Main results and the role of chance Among the 14.3 million women aged 15–49 living in metropolitan France covered by the health insurance, 26.0% were using the pill, 17.4% an IUD (7.6% hormonal IUD; 9.9% copper IUD), and 3.1% an etonogestrel implant. These proportions are very close to and not statistically different from those observed in the population-based survey (26.2% for the pill, 18.4% IUD, and 3.1% implant). Contraceptive use varied widely with women’s age. At ages 20–24, the most widely used contraceptive was the pill (42.2%), and very few long-acting contraceptives were used (7.6% IUD; 4.9% implant). At ages 30–34, the pill was less frequently used (21.6%) and IUD more frequently used (copper IUD: 15.79%; hormonal IUD: 7.06%). Limitations, reasons for caution It cannot be ruled out that some contraceptives were purchased but never used and that a few women stopped using the contraceptive before the end of its recommended duration. Wider implications of the findings: To our knowledge, this study is the first to estimate prevalence for Copper IUD and for hormonal IUD in France. Using the national health insurance database, it is now possible to monitor the use of each type of medical contraceptive over time in a reliable population-based approach. Trial registration number Not applicabl

Medical contraceptive use in the French population: Can we explore it based on the national health insurance data?

Study question. Are French national health insurance data reliable for studying the use of medical contraception? Summary answer. Health insurance data produce a measurement of contraceptive use consistent with population-based survey data, which affords new opportunities for studying contraception. What is known already. Medical contraception is a major public health issue as most women of reproductive age use it. It is usually studied through population-based surveys. However, such surveys are conducted only every 10 years, and analyses are limited by their sample size. French national health insurance data provide comprehensive and time-continuous information on each reimbursed contraceptive. However, because these data have been collected for a different purpose (reimbursement), their relevance for measuring the use of contraceptives needs to be assessed. Study design, size, duration: Two sources were analysed. First, a cross-sectional cohort was extracted from the health insurance database, which includes all health reimbursements (such as those for medical contraceptives) and covers 98% of the French population, including 14 million women aged 15–49. Secondly, we used the last French survey on contraception, a cross-sectional study including 4,508 women aged 15–49 interviewed by phone. Participants/materials, setting, methods. From both sources, we selected all women aged 15–49 living in metropolitan France. We identified the last medical contraceptive purchased by each woman between 2014 and 2019. The woman was then classified as currently using this contraceptive if the recommended duration of use for this contraceptive was still ongoing on 31 December 2019. Prevalences were compared to those observed in the population based survey. Main results and the role of chance. Among the 14.3 million women aged 15–49 living in metropolitan France covered by the health insurance, 26.0% were using the pill, 17.4% an IUD (7.6% hormonal IUD; 9.9% copper IUD), and 3.1% an etonogestrel implant. These proportions are very close to and not statistically different from those observed in the population-based survey (26.2% for the pill, 18.4% IUD, and 3.1% implant). Contraceptive use varied widely with women’s age. At ages 20–24, the most widely used contraceptive was the pill (42.2%), and very few long-acting contraceptives were used (7.6% IUD; 4.9% implant). At ages 30–34, the pill was less frequently used (21.6%) and IUD more frequently used (copper IUD: 15.79 %; hormonal IUD: 7.06%). Limitations, reasons for caution. It cannot be ruled out that some contraceptives were purchased but never used and that a few women stopped using the contraceptive before the end of its recommended duration. Wider implications of the findings. To our knowledge, this study is the first to estimate prevalence for Copper IUD and for hormonal IUD in France. Using the national health insurance database, it is now possible to monitor the use of each type of medical contraceptive over time in a reliable population-based approach. Trial registration number. not applicabl

La contraception médicalisée en France, peut-on l'étudier à partir des données administratives de santé ?

Conference Abstract publié dans : Revue d'Épidémiologie et de Santé Publique, Volume 70, Supplement 1, March 2022, Pages S19-S20 https://doi.org/10.1016/j.respe.2022.01.09

Chlamyweb Study I: rationale, design and acceptability of an internet-based chlamydia testing intervention

Objectives In recent years, the internet has widely facilitated Chlamydia trachomatis home-sampling. In France (2012), the Chlamyweb Study evaluated an intervention (Chlamyweb) involving home-based self-sampling via the internet. One element of the study consisted of a randomised controlled trial (RCT), which is reported in detail elsewhere. The focus of this paper, however, is on describing the Chlamyweb Intervention and reporting on the non-RCT element of the evaluation of that intervention by the Chlamyweb Study. This involves (1) describing the design and roll-out of the Chlamyweb Intervention, (2) comparing the socio-behavioural profiles of the participants in the intervention with a nationally representative general population sample and (3) examining the factors that influence the acceptance and return of a self-sampling kit supplied to participants in the course of the intervention.Methods Self-sampling kits were offered to sexually active people aged 18–24 years living on the mainland French. Participants' characteristics were compared with the general population to describe recruited and participant populations. Multivariate analyses by conditional logistic regression were performed to determine factors that were predictors of kit acceptation and use.Results 7215 people aged 18–24 years were included. Compared with the general population, Chlamyweb reached larger proportions of women, younger people and people with several partners in the previous year. 3372 (46.7%) agreed to receive a self-sampling kit and 2084 (61.8%) returned it, with more women doing so than men. The participation rate was associated with age, place of birth, occupational status, number of partners and condom use, differently for men and women.Conclusion The offer of easy-to-use, self-sampling kits free of charge appeared to be a logistically feasible strategy for testing in France and reached a large and diverse population including individuals who have limited access to the traditional healthcare system

Anal and oropharyngeal HPV distribution in HIV‐negative multipartner MSM using self‐sampling kits for HIV and sexually transmitted infection screening

International audienceAbstract Men who have sex with men (MSM) are at high risk of sexually transmitted infections, among which HPV infections are particularly prominent. We took advantage of the MémoDépistages study to evaluate HPV distribution at anal and oropharyngeal sites in HIV‐negative multipartner MSM. HPV DNA was detected in 82% ( n = 344) of anal and 11% ( n = 45) of oropharyngeal self‐collected samples taken from 421 participants. Multiple HPV types were detected in 70% of anal samples, and single HPV types in 91% of oropharyngeal samples. HPV16 was the most frequent type detected in the anus, followed by HPV6, HPV51, and HPV52. HPV6, HPV16, and HPV11 were the most prevalent types in the oropharynx. HPV targeted by the nonavalent vaccine was detected in 71% and 50% of HPV‐positive anal and oropharyngeal samples, respectively. The main risk factor associated with HPV detection was frequenting gay meeting places, living in large cities, and having an anal Chlamydia trachomatis / Neisseria gonorrhoeae infection. In this cohort of highly sexually active MSM, HPV detection was highly frequent and rendered them at high risk of precancerous and cancerous lesions. Universal vaccination against HPV before sexual debut is an important public health strategy to prevent HPV‐associated cancers in this highly vulnerable population of HIV‐negative MSM

Comparing the Information and Support Needs of Different Population Groups in Preparation for 2015 Government Approval for HIV Self-testing in France

<div><p>Context</p><p>HIV self-tests are currently being introduced in France with the aim of promoting screening both for the general population and for high-risk populations.</p><p>Objective</p><p>The current study aimed to identify and compare the information and support needs of the different target population groups.</p><p>Methods</p><p>The Delphi process was used to synthesize expert opinions for each population group. Experts were chosen for their experience and expertise in the area of HIV and HIV screening for each population. Each group developed recommendations for a specific population: six high HIV prevalence populations (men who have sex with men; transgender people; substance users; migrants from sub-Saharan Africa; French West Indies; French Guiana) and two low prevalence populations (the general population; people under 25). Each group included expertise from four areas: research, screening and care, policy-making, and community groups.</p><p>Results</p><p>A final total of 263 recommendations were grouped into eight main themes: <i>Communicating at both national and community levels about self-test arrival</i> (24% of all recommendations); <i>Providing information adapted to the different community groups’ needs</i> (23%); <i>Providing counselling on self-test use and access to care</i> (15%); <i>Making self-tests available to all in terms of accessibility and cost</i> (13%); <i>Preparing community healthcare and screening systems for the arrival of the self-test</i> (11%); <i>Approving only high quality self-tests</i> (6%); <i>Defending self-test users’ legal rights</i> (5%); <i>Evaluating self-test use</i> (3%). Although a large number of recommendations were common to several groups of experts, the study highlighted a certain number of recommendations specific to each different population group, particularly with regard to information content and access both to information and to the self-tests themselves.</p><p>Conclusion</p><p>Results from the current study should make a significant contribution to policy decisions concerning catering for the specific access, information and support needs of different potential HIV self-test user groups in France.</p></div

Risk Factors for Community and Intrahousehold Transmission of SARS-CoV-2: Modeling in a Nationwide French Population-Based Cohort Study, the EpiCoV Study

International audienceAbstract We assessed the risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from household and community exposure according to age, family ties, and socioeconomic and living conditions using serological data from a nationwide French population-based cohort study, the Epidémiologie et Conditions de Vie (EpiCoV) Study. A history of SARS-CoV-2 infection was defined by a positive anti-SARS-CoV-2 enzyme-linked immunosorbent assay immunoglobulin G result in November–December 2020. We applied stochastic chain binomial models fitted to the final distribution of household infections to data from 17,983 individuals aged ≥6 years from 8,165 households. Models estimated the competing risks of being infected from community and household exposure. The age group 18–24 years had the highest risk of extrahousehold infection (8.9%, 95% credible interval (CrI): 7.5, 10.4), whereas the oldest (≥75 years) and youngest (6–10 years) age groups had the lowest risk, at 2.6% (95% CrI: 1.8, 3.5) and 3.4% (95% CrI: 1.9, 5.2), respectively. Extrahousehold infection was also associated with socioeconomic conditions. Within households, the probability of person-to-person transmission increased with age, from 10.6% (95% CrI: 5.0, 17.9) among children aged 6–10 years to 43.1% (95% CrI: 32.6, 53.2) among adults aged 65–74 years. Transmission was higher between partners (29.9%, 95% CrI: 25.6, 34.3) and from mother to child (29.1%, 95% CrI: 21.4, 37.3) than between individuals related by other family ties. In 2020 in France, the main factors identified for extrahousehold SARS-CoV-2 infection were age and socioeconomic conditions. Intrahousehold infection mainly depended on age and family ties

Number of recommendations for each major theme.

<p>Number of recommendations for each major theme.</p